Comparison of Clinical Characteristics, Complications, and Outcomes in Recipients Having Heart Transplants <65 Years of Age Versus ≥65 Years of Age

• Published in: The American journal of cardiology 2017-12, Vol.120 (12), p.2207-2212
• Main Authors: Jamil, Aayla, Qin, Huanying, Felius, Joost, Saracino, Giovanna, Rafael, Aldo E., MacHannaford, Juan C., Gonzalez-Stawinski, Gonzalo V., Lima, Brian
• Format: Article
• Language: English
• Subjects: Age; Age Distribution; Age Factors; Aged; Atherosclerosis; Bleeding; Body mass; Cardiomyopathy; Complications; Creatinine; Cytomegalovirus; Female; Follow-Up Studies; Graft Rejection - epidemiology; Graft Survival; Heart; Heart Diseases - mortality; Heart Diseases - surgery; Heart failure; Heart Transplantation; Heart transplants; Hospital Mortality - trends; Humans; Incidence; Ischemia; Kidneys; Length of Stay - trends; Male; Middle Aged; Morbidity; Nutritional status; Oxazines; Patient Selection; Patients; Population studies; Postoperative Complications - epidemiology; Renal failure; Retrospective Studies; Survival; Survival Rate - trends; Time Factors; Transplant Recipients; Transplants; Transplants & implants; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.08.043

Advanced recipient age remains a limiting factor for heart transplant candidacy, with many centers reluctant to transplant older patients. Here, we report our experience with recipients aged ≥65 years compared with younger recipients in terms of baseline characteristics, intraoperative and immediate postoperative experiences, and post-transplant morbidity and survival. The main study outcome was primary graft dysfunction (PGD), which has not been widely studied in this population. Donor and recipient data from 255 heart transplantations performed between 2012 and 2016 were reviewed. Seventy (27%) recipients were ≥65 years and 185 were younger. The older group had a higher frequency of ischemic cardiomyopathy and more frequently had a previous sternotomy than the younger recipients (all p 0.12). One-year survival was also similar in the 2 groups (p = 0.88). The incidence of moderate or severe PGD was lower in the older group (6%) than in the younger group (16%; p = 0.037). Multivariate logistic regression found pretransplant creatinine and donor undersizing by predicted heart mass to be predictors of moderate to severe PGD, whereas recipient age ≥65 years was identified as protective against PGD in this cohort. In conclusion, our study showed comparable survival and outcomes in recipients ≥65 years of age with otherwise similar nutritional status and body mass composition.